Top

Archives of Gynecology and Obstetrics

Published in:

01-02-2018 | General Gynecology

Clinical effect of emergency cervical cerclage and elective cervical cerclage on pregnancy outcome in the cervical-incompetent pregnant women

Authors: Qin Chen, Guiying Chen, Nan Li

Published in: Archives of Gynecology and Obstetrics | Issue 2/2018

Abstract

Purpose

To compare the clinical effect of emergency cervical cerclage and elective cervical cerclage on pregnancy outcome in the cervical-incompetent pregnant women.

Methods

Literature was searched from the databases of Pubmed, Embase and Google scholar. The fixed or random effects model was used to calculate pooled risk ratios on the basis of heterogeneity. Meta-regression, sensitive analysis, subgroup analysis, and publication bias assessment were also conducted to confirm the results according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009.

Results

The meta-analysis results showed that there were significant associations between cerclage operations and pregnancy outcomes in gestation age, birth weight, and PROM rate. Gestation age was significantly higher in women with elective cerclage than those with emergency cerclage, and birth weight was significantly higher in newborns for the elective group as compared with emergency group. The rate of PROM in elective group was lower than emergency group. However, there were no differences between the emergency cerclage group and the elective cerclage group regarding the rate of vaginal delivery.

Conclusions

This meta-analysis suggests that emergency cerclage has lower gestation age and birth weight than elective cerclage, and it increases the risk of PROM. Further well-designed studies are warranted to confirm these results.

Lash AF, Lash SR (1950) Habitual abortion; the incompetent internal os of the cervix. Am J Obstet Gynecol 59(1):68–76CrossRefPubMed

Frey HA, Klebanoff MA (2016) The epidemiology, etiology, and costs of preterm birth. Semin Fetal Neonatal Med 21(2):68–73CrossRefPubMed

Gluck O, Mizrachi Y, Ginath S, Bar J, Sagiv R (2016) Obstetrical outcomes of emergency compared with elective cervical cerclage. J Matern Fetal Neonatal Med 30(14):1650–1654CrossRefPubMed

Khan MJ, Ali G, Al Tajir G, Sulieman H (2012) Evaluation of outcomes associated with placement of elective, urgent, and emergency cerclage. J Obstet Gynaecol India 62(6):660–664CrossRefPubMedPubMedCentral

Liddiard A, Bhattacharya S, Crichton L (2011) Elective and emergency cervical cerclage and immediate pregnancy outcomes: a retrospective observational study. JRSM Short Rep 2(11):91CrossRefPubMedPubMedCentral

Kassanos D, Salamalekis E, Vitoratos N, Panayotopoulos N, Loghis C, Creatsas C (2001) The value of transvaginal ultrasonography in diagnosis and management of cervical incompetence. Clin Exp Obstet Gynecol 28(4):266–268PubMed

Kurup M, Goldkrand JW (1999) Cervical incompetence: elective, emergent, or urgent cerclage. Am J Obstet Gynecol 181(2):240–246CrossRefPubMed

Cardosi RJ, Chez RA (1998) Comparison of elective and empiric cerclage and the role of emergency cerclage. J Matern Fetal Med 7(5):230–234PubMed

Nelson L, Dola T, Tran T, Carter M, Luu H, Dola C (2009) Pregnancy outcomes following placement of elective, urgent and emergent cerclage. J Matern Fetal Neonatal Med 22(3):269–273CrossRefPubMed

10.

Wu MY, Yang YS, Huang SC, Lee TY, Ho HN (1996) Emergent and elective cervical cerclage for cervical incompetence. Int J Gynaecol Obstet 54(1):23–29CrossRefPubMed

11.

Guzman ER, Forster JK, Vintzileos AM, Ananth CV, Walters C, Gipson K (1998) Pregnancy outcomes in women treated with elective versus ultrasound-indicated cervical cerclage. Ultrasound Obstet Gynecol 12(5):323–327CrossRefPubMed

12.

Guzman ER, Houlihan C, Vintzileos A (1995) Sonography and transfundal pressure in the evaluation of the cervix during pregnancy. Obstet Gynecol Surv 50(5):395–403CrossRefPubMed

13.

Hole J, Tressler T, Martinez F (2003) Elective and emergency transabdominal cervicoisthmic cerclage for cervical incompetence. J Reprod Med 48(8):596–600PubMed

14.

Hua W, Wei Z, Ling F, Song Y, Jian-Rong M, Ping W (2014) Effects of maternal cervical incompetence on morbidity and mortality of preterm neonates with birth weight less than 2000 g. Iran J Pediatr 24(6):759–765PubMedPubMedCentral

15.

Jalal EM, Moretti F, Gruslin A (2016) Predictors of outcomes of non-elective cervical cerclages. J Obstet Gynaecol Can 38(3):252–257CrossRefPubMed

16.

Kokia E, Dor J, Blankenstein J, Seidman DS, Lipitz S, Serr DM, Mashiach S (1991) A simple scoring system for the treatment of cervical incompetence diagnosed during the second trimester. Gynecol Obstet Investig 31(1):12–16CrossRef

17.

Lotgering FK, Gaugler-Senden IP, Lotgering SF, Wallenburg HC (2006) Outcome after transabdominal cervicoisthmic cerclage. Obstet Gynecol 107(4):779–784CrossRefPubMed

18.

Mikulandra F, Perisa M, Merlak I, Stojnic E, Balic J (1993) Pregnancy and delivery in women aged 35 years and over. Zentralbl Gynakol 115(4):171–176PubMed

19.

Parilla BV, Haney EI, Macgregor SN (2003) The prevalence and timing of cervical cerclage placement in multiple gestations. Int J Gynaecol Obstet 80(2):123–127CrossRefPubMed

20.

Rafael TJ, Berghella V, Alfirevic Z (2014) Cervical stitch (cerclage) for preventing preterm birth in multiple pregnancy. Cochrane Database Syst Rev 10(9):CD009166. https://doi.org/10.1002/14651858.CD009166.pub2

21.

Toaff R, Toaff ME, Ballas S, Ophir A (1977) Cervical incompetence: diagnostic and therapeutic aspects. Isr J Med Sci 13(1):39–49PubMed

22.

Li Q, Qiao Y, Wang C, Zhang G, Zhang X, Xu L (2016) Associations between two single-nucleotide polymorphisms (rs1801278 and rs2943641) of insulin receptor substrate 1 gene and type 2 diabetes susceptibility: a meta-analysis. Endocrine 51(1):52–62CrossRefPubMed

23.

Abu Hashim H, Al-Inany H, Kilani Z (2014) A review of the contemporary evidence on rescue cervical cerclage. Int J Gynaecol Obstet 124(3):198–203CrossRefPubMed

24.

Algara AC, Rodriguez AG, Vazquez AC, Valladares FE, Ramirez PG, Padilla EL, Bandala C, Hernandez SL (2015) Laparoscopic approach for fibroid removal at 18 weeks of pregnancy. Surg Technol Int 27:195–197PubMed

25.

Brown R, Gagnon R, Delisle MF, Maternal Fetal Medicine C, Gagnon R, Bujold E, Basso M, Bos H, Brown R, Cooper S, Crane J, Davies G, Gouin K, Menticoglou S, Mundle W, Pylypjuk C, Roggensack A, Sanderson F, Senikas V (2013) Cervical insufficiency and cervical cerclage. J Obstet Gynaecol Can 35(12):1115–1127

26.

Chanrachakul B, Herabutya Y (1998) Emergency cervical cerclage: Ramathibodi Hospital experience. J Med Assoc Thail 81(11):858–861

27.

Harger JH (2002) Cerclage and cervical insufficiency: an evidence-based analysis. Obstet Gynecol 100(6):1313–1327PubMed

28.

Berghella V, Haas S, Chervoneva I, Hyslop T (2002) Patients with prior second-trimester loss: prophylactic cerclage or serial transvaginal sonograms? Am J Obstet Gynecol 187(3):747–751CrossRefPubMed

29.

Simcox R, Shennan A (2007) Cervical cerclage: a review. Int J Surg 5(3):205–209CrossRefPubMed

30.

Simcox R, Shennan A (2007) Cervical cerclage in the prevention of preterm birth. Best Pract Res Clin Obstet Gynaecol 21(5):831–842CrossRefPubMed

31.

Tsapanos VS, Decavalas GO, Adonakis GL, Kourounis GS (2005) Late or emergency (salvage) cerclage of a dilated cervix after tissue support with Pelvicol implant: a case. J Biomed Mater Res B Appl Biomater 72(2):368–372CrossRefPubMed

Title: Clinical effect of emergency cervical cerclage and elective cervical cerclage on pregnancy outcome in the cervical-incompetent pregnant women
Authors: Qin Chen
Guiying Chen
Nan Li
Publication date: 01-02-2018
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 2/2018
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-017-4602-7

At a glance: The STEP trials

Springer Medicine

Clinical effect of emergency cervical cerclage and elective cervical cerclage on pregnancy outcome in the cervical-incompetent pregnant women

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2018

Is surgical plume developing during routine LEEPs contaminated with high-risk HPV? A pilot series of experiments

Re: Estimation of neonatal outcome artery pH value according to CTG interpretation of the last 60 min before delivery: a retrospective study. Can the outcome pH value be predicted?

Stimulation of chemokines in human endometrial stromal cells by tumor necrosis factor-α and interferon-γ is similar under apoptotic and non-apoptotic conditions

Laparoscopic-assisted vaginal hysterectomy versus vaginal hysterectomy for benign uterine diseases: a prospective, randomized, multicenter, double-blind trial (LAVA)

Candidate biomarkers in the cervical vaginal fluid for the (self-)diagnosis of cervical precancer

The role of serum ADAMTS-1 and aggrecan on polycystic ovary syndrome in adolescents and younger-aged females